The SCORE2 study showed that intravitreal bevacizumab is non-inferior to aflibercept as a treatment for macular edema due to central retinal or hemiretinal vein occlusion with respect to visual acuity.
The trial involved 66 centers in the U.S. and included 362 patients randomized to receive 1.25 mg Avastin (bevacizumab, Genentech) or 2 mg Eylea (aflibercept, Regeneron) every 4 weeks over a period of 6 months. Bevacizumab was divided into single dose units by the Investigational Drug Service of the University of Pennsylvania. The primary outcome was mean change in best-corrected ETDRS visual acuity letter score and the non-inferiority margin was five letters. Visual acuity assessment, OCT examination, fundus photography and flourescein angiography were performed at each monthly visit.
At month 6, a gain of at least 15 letters was reported in 65.1% of eyes in the aflibercept group and 61.3% of eyes in the bevacizumab group. In both groups, less than 2% of the eyes lost 15 or more letters. Both groups showed a statistically significant OCT-measured decrease in central subfield thickness, but a significantly lower percentage of eyes in the bevacizumab group had complete resolution of macular edema at 6 months. As the authors note, “this did not translate into poorer VA outcomes.” Adverse events were comparable in both groups.
As pointed out by the authors, “cost is one of many factors that may contribute to drug selection when treating patients.” Because the cost of bevacizumab is 30 times lower than the cost of aflibercept and because most patients treated for macular edema associated with retinal vein occlusion need repeated doses of anti-VEGF, “the cost differential between the two drugs has important economic implications,” the authors wrote. – by Michela Cimberle
Disclosure: Scott reported serving as a data and safety monitoring committee member for
ThromboGenics. Please see the study for the other authors’ relevant financial disclosures.